ARTICLE INFO ABSTRACT The purpose of the study is to establish the role of magnetic resonance imaging (MRI) in the evaluation of various causes of compressive myelopathy, characterization of compressive lesions and to classify the lesions based on location into extradural / intradural compartments. Seventy patients who were clinically suspected to have compressive myelopathy were subjected for MRI. In this study, extradural compression due to degenerative changes (54.3%) was found to be the most common cause of compressive myelopathy, followed by infectious spondylitis (14.3%), post traumatic compressive myelopathy (12.8%), primary neoplasms & metastases (12.8%) and other causes (5.8%). There were 6 cases of intradural extramedullary pathology, remainder (64 cases) of the cases showed extradural location of pathology. MRI detected cord changes in 97% of cases with cord compression and also assessed the integrity of spinal cord, intervertebral discs and ligament after acute spinal trauma. MRI is very definitive, sensitive, accurate, though costly but very specific, non-invasive, radiation free modality for evaluation of compressive myelopathy.

MRI was performed on patients with miliary pulmonary tuberculosis to look for brain involvement and to study the features sequentially, during treatment. We studied seven patients with typical radiographic tuberculosis, and no symptoms or signs of central nervous system involvement. Conventional spin-echo (SE) imaging, including contrast enhanced images, was performed in all cases. All patients showed brain involvement: four patients showed lesions mainly less than 3 mm in diameter, better seen on contrast-enhanced images. These patients showed oedema around the lesions after 2 months of treatment, with subsequent regression on follow-up. The remaining three patients had multiple lesions, 3 mm or more in diameter, which showed a gradual decrease on follow-up. We conclude that the brain may commonly be involved in miliary pulmonary tuberculosis. The response to treatment depends on the stage of the granuloma and shows a definite pattern of healing on follow-up.

We examined four patients with fluorosis, presenting with compressive myelopathy, by MRI, using spin-echo and fast low-angle shot sequences. Cord compression due to ossification of the posterior longitudinal ligament (PLL) and ligamentum flavum (LF) was demonstrated in one and ossification of only the LF in one. Marrow signal was observed in the PLL and LF in all the patients on all pulse sequences. In patients with compressive myelopathy secondary to ossification of PLL and/or LF, fluorosis should be considered as a possible cause, especially in endemic regions.

Background and Aims: Perfusion index (PI) is a new simple, objective and non-invasive method for evaluation of the success of central neuraxial and peripheral nerve blocks. So, we conducted a study with an aim to evaluate PI as an indicator for success of ultrasound-guided supraclavicular block (SCB). Methods: 65 patients of either sex, age 18–60 years, American Society of Anesthesiologists physical status I and II posted for upper limb surgery under ultrasound (US)-guided SCB were included. PI was recorded at baseline every 2 minutes till 10 minutes and then every 5 minutes till 30 minutes after block. PI ratio was calculated as the ratio between PI at 10 minutes and baseline PI. Sensory and motor blocks were assessed at 5-minutes intervals up to 30 minutes. Descriptive analysis was applied by mean and standard deviation for quantitative, frequency and proportion for categorical variables. Results: Mean PI increased continuously from baseline and reached the maximum at 10 minutes and then slightly decreased up to 30 minutes, but values at subsequent time intervals were quite high as compared to baseline. In case of successful blocks, median PI started increasing 2 minutes after the block and then increased in a linear fashion till 10 minutes, whereas in case of failed blocks, it only increased minimally. Conclusion: PI is an objective and faster indicator for evaluating success of US-guided SCB. A cut-off value of 3.25 for PI and 3.03 for PI ratio showed a fairly good ability with high sensitivity and specificity for predicting the success of SCB.